Pharmacology in Pain Management

Question 1

mild pain

Answer 1

(1-3)

-use step 1 drugs (NSAIDS & acetaminophen)

Question 2

pain is a reflection of what?

Answer 2

emotion and attitude

Question 3

R: region

Answer 3

where is it? does it stay there?

Question 4

treatments

Answer 4

-2nd line:
Tryptans are serotonin/ 5-HT-1 receptors against that constrict intracranial vessels.
sumatriptans, zolmitriptan, rizatriptan, etc. (have various half-lives, times of onset)

some also come in combo, sumatriptan plus naproxin

Question 5

tension headaches

Answer 5

• dull quality, pain radiates to forehead, neck, shoulders

Question 6

how do we assess pain?

Answer 6

PQRSTU

Question 7

severe pain

Answer 7

(7-10)

-use opiates/ step 3 (morphine, hydromorphone/dilaudid, oxycodone/oxycontin, oxymorphone, Fentora)

Question 8

Local anesthetics

Answer 8

sodium channel blockers that reduce pain impulses (novocaine)
(lidocaine)

Question 9

transmission

Answer 9

through dorsal horn of cord; if signal is strong enough, may reach CNS, though there are inhibitory fibers in cord to reduce upstream signal

Question 10

treatment of tension headache

Answer 10

• acetaminophen & aspirin (1st line)
• NSAIDS (2nd line)
  
  • can give antiemetics if accompanying nausea (promethazine/ prochlorperazine)
• combination of meds: (3rd line)
• Fioricet (butalbital/ acetaminophen/ caffeine)
• Fiorinal (butalbital/ aspirin/ caffeine)
• *** some anti-depressants also used, including amitriptyline, fluoxetine, others

Question 11

chronic pain:

Answer 11

• lasts over 3-6 months
• pain persists after injury has healed
• can be from a variety of tissues
• perhaps the result of “neuroplasticity”

Question 12

anti-convulsants

Answer 12

gabapentin & pregabalin activate GABA receptors & reduce neutotransmitters

Question 13

acute pain

Answer 13

sudden onset & related to a specific case (trauma/damage)

• can be accompanied by other physiological responses, (increased HR, sweating, rapid breathing)

Question 14

Treating pain

Answer 14

mild pain
moderate pain
severe pain

Question 15

what is pain?

Answer 15

Unpleasant sensory & emotional experience associated w/ actual or potential tissue damage

Question 16

signal reducers

Answer 16

those that normally inhibit pain signals

-B-endorphin (mu receptors), NE, and GABA

Question 17

what is pain pathophysiology?

Answer 17

transduction
transmission
perception
modulation

Question 18

mediators or pain signals

Answer 18

PG’s, substance P (even stimulating second order neurons in cord)
bradykinins

Question 19

P: precipitating/ palliating

Answer 19

what makes it worse or better?

Question 20

treatments

Answer 20

-3rd line:
Ergot derivatives (ergotamine or dihydroergotamine)
lead to vasoconstriction

Question 21

Co-Analgesics for pain

Answer 21

Antidepressants
Anticonvulsants
Local Anesthetics
Muscle Relaxants

Question 22

Migraine triggers?

Answer 22

• physiologic factors(anxiety, depression)
• medications (hormones, nicotine, nitroglycerin)
• diet (alcohol, caffeine, chocolate)
• environment (light, altitude, odors, sounds, weather)
• lifestyle (dieting, exercise, sleep patterns)
• hormonal factors (pregnancy, menopause)

Question 23

transduction

Answer 23

A-delta nerves and C-nerves (fibers) are activated by PGs, substance P, histamine, etc

Question 24

modulation

Answer 24

inhibitory effects in the CNS to reduce the sense of pain in a descending pathway

Question 25

moderate pain

Answer 25

(4-6) | -use NSAIDS plus opiates/ step 2 (hydrocodone/Vicodin, oxycodone/Percocet)

Question 26

S: severity

Answer 26

Pain scales?

Question 27

treatments

Answer 27

-1st line: (NSAIDS & aspirin) caffeine- containing meds (Excedrin (migraine))

Question 28

perception

Answer 28

signals in both the cortex and limbic system = COGNITIVE & EMOTIONAL component

Question 29

cluster headaches

Answer 29

disabling, burning, or boring feeling around one eye & extremely painful

Question 30

migraine

Answer 30

head throbbing, nausea, photophobia, photophobia, and can be debilitating

Question 31

Headaches

Answer 31

tension headaches migraines cluster headaches

Question 32

anti-depressants

Answer 32

tricyclics & SNRI will reduce NE uptake & help reduce neurotransmitters in nociception (amitriptyline & venlafaxine)

Question 33

chronic pain

Answer 33

LONG-LIVED acute pain where patients can accommodate to the physiological response - CAN OFTEN LEAD TO DEPRESSION AND ANXIETY

Question 34

what causes migraine headaches?

Answer 34

- can be genetic somewhat, often associated w/ LOW estrogen levels - thought to be vascular (too much vasodilation in cranial vessels) but NOW, believed to be more neurogenic, involving neurons from the trigeminal nerve leading to vasodilation of meningeal blood vessels, release of inflammatory agents, more dilation, then headache

Question 35

what causes tension headaches?

Answer 35

- thought to be due to muscle tone in pericardial region - often associated with sleep deprivation, smoking, cessation - if treated too often, can lead to MOH (medication Overuse Headache)

Question 36

types of pain

Answer 36

nociceptive neuropathic acute chronic

Question 37

Q: quality

Answer 37

what does it feel like?

Question 38

T: temporal patterns

Answer 38

is it constant? intermittent?

Question 39

Prophylaxis of migraines

Answer 39

- 1st line: Beta blockers (propanolol, metoprolol, atenolol, etc) or tricyclic antidepressants (imipramine, nortriptyline, amitriptyline) anticonvulsants (valproic acid, topiramate) Calcium Channel Blockers

Question 40

neuropathic pain

Answer 40

from CNS processing following insult from disease or trauma such as: tingling, burning, shooting, etc.,

Question 41

Muscle relaxants

Answer 41

likely only used when pain is related to muscle spasm

Question 42

Rescue agent?

Answer 42

opioids such as: butorphanol or codeine can be used

Question 43

U: you

Answer 43

how does it affect you?

Question 44

nociceptive pain

Answer 44

from stimulation of neurons following injury, disease of inflammation of tissue - can be somatic (muscle, skin, or bone associated) - can be visceral (organ associated)